HMN 2026: How Half of trans people pay for gender affirming surgery themselves

One in three people in Norway (32.5%) who have started hormone treatment, and half (49.5%) of those who have undergone gender affirming surgery, have obtained treatment entirely through private funding. That is the findings of a new survey involving 579 trans and nonbinary individuals from across the country. The paper is published in the journal BMC Public Health.

“Even though publicly funded treatment is available, many still choose to pay for care themselves. It’s striking, especially given that the participants were largely young people with low incomes,” says Silje-Håvard Bolstad, doctoral research fellow at the Department of Psychosocial Health at the University of Agder.

At the same time, the survey shows that many of those with unmet needs for treatment could not afford to pay for it privately. For hormone treatment, this applied to around 46%, and for surgery around 66%.

Long waiting times and fear of being turned down

In Norway, publicly funded gender affirming medical treatment is available at Oslo University Hospital.

The study did not specifically investigate why some people choose to seek treatment outside the public healthcare system, but Silje-Håvard Bolstad points to several possible explanations:

• Long waiting lists
• Assessments that takes at least one year
• Fear of being rejected after a lengthy assessment process
• Lack of knowledge about gender diversity within the health care system
• Nonbinary people being denied treatment
• Insufficiently individualized treatment options

Also, 58% of participants in the study had experienced discrimination within the healthcare system, either in connection with gender affirming treatment or when seeking other forms of care.”Some of those seeking gender affirming treatment may have low trust in the public healthcare services, and therefore choose to pursue private treatment instead,” Bolstad says.

Satisfied with treatment

The survey also shows that the vast majority of those who have received treatment are satisfied with the results: 93% of those who received hormone treatment and 96% of those who underwent surgery.

Thirty five percent of trans men in the study had completed most of the gender affirming changes they wanted. The corresponding figures were 18% for trans women and 16% for nonbinary people assigned female at birth.

Among nonbinary people assigned male at birth, none had completed most of the changes they wanted.

“Nonbinary people may have different goals for their transition than what is typical among trans men and trans women. Some may not want extensive medical treatment, but instead prefer social changes or more moderate medical interventions,” the researcher explains.

Bolstad emphasizes that trans people are a diverse group. “The findings highlight how important it is to tailor gender affirming treatment to individual needs.”

Many report mental health difficulties

Fewer than half of the participants (47%) reported having good general health, compared with 68% in studies of the general population.

“The survey aligns with much of what previous research has shown. The proportion experiencing mental health problems at a level requiring treatment was almost four times higher than in the general population. One in three has attempted suicide at some point in their lives, which is twelve times higher than what is found in studies of the general population,” says Bolstad.

Studies from many countries show that access to gender affirming treatment can reduce mental health difficulties and prevent suicide among trans people.

“When we know that this group experiences significant mental health challenges, and that gender affirming treatment leads to improvement, it is deeply concerning that they face so many barriers to accessing care, and that the public treatment services are so limited and difficult to reach,” Bolstad says.

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